FAMILY NURSING & HOME NURSING

­­­FAMILY NURSING

 INTRODUCTION:

                                    Nursing care directed to improving the potential health of a family or any of its members by assessing individual and family health needs and strengths, by identifying problems influencing the health care of the family as a whole and those influencing the individual members, by using family resources, by teaching and counseling, and by evaluating progress towards stated goals.  

  “Family health services” is the central point of health services. It t is an important component of ‘health for all’ goal. Health of each individual affects the health of other members of the family. Each family has different background, thinking, style of living, customs and economic level etc. Therefore it essential for the community health nurse to have a sound knowledge of family. Family nursing refers to nursing care that is holistically directed the whole family as well as individual members. It aims at overall welfare of family.

FAMILY HEALTH:

   Family health is a dynamic, changing, relative state of well-being which includes the biological, psychological, spiritual, sociological, and culture factors of the family system.

FAMILY HEALTH NURSING:

      “Family health nursing is the practice of nursing directed towards maximizing the health and wellbeing of all individuals within a family system.”

                  It is the provision of care involving the nursing process, to families and family members in health and illness situations.

      Family health nursing views the family as a system existing within larger system. Levels of intervention are the individuals, the personal, the family system, and the environmental level.

      The goal of the family health nursing includes optimal functioning for the individual and for the family as a unit.

       It incorporates two views of family: Family as a unit of care and family as a contact.

   “Family as a unit of care means that the entire family is recipient of nursing intervention that is standards of community health nursing practice that identifies client as an individual, family and community.”

   “Family as a contact recognizes the impact of family on an individual that is the need to understand the family environment in which the individual exists.”

 OBJECTIVES OF FAMILY HEALTH NURSING

·         To identify health and nursing needs and problems of each family.

·         To ensure family’s understanding and acceptance of these needs and problems.

·         To plan and provide health and nursing services with the active participation of family members.

·         To help families develop abilities to deal with their health need and health problems independently.

·         To contribute families pursuance of developmental functions and tasks.

·         To help family make intelligent use of promotive, preventive, therapeutic and rehabilitative health and allied facilities and services in the community.

·         To educate, counsel and guide family members to cultivate good personal health habits, practice safe cultural practices and maintain wholesome physical, psychological and spiritual environment.

PRINCIPLES OF FAMILY NURSING

·         Family health nursing is family focused means to know the family from various aspects which include family structure and characteristics, socioeconomic and cultural factors, environmental factors, and health and family medical history of family members.

·         Must establish good working relationship with the family to know each other and work together to plan implement and evaluate family health and nursing care.

·         It is based on identified family health and nursing need means needs to know family health care policies, goals, objectives and the nature of family health care services.

·         It should be realistic in terms of resources available. This requires proper estimation of health needs, health problems and resources in terms of money, manpower, material and time.

·         It is essential to attain working knowledge of the community to help family to develop favorable attitude towards community and utilize community resources.

·         Family as a unit is responsible for their member’s health and has a right to make health care decisions.

·         Health education, guidance and supervision are integral part of family health nursing. This is needed to help the family to improve knowledge, develop competences, and create interest and become self dependent.

·         Continuous services are effective services to promote and maintain health and prevent diseases.

·         Effective system of record and report of family health nursing services is essential. It is an effective means for continuous care and its evaluation and further planning.

·         Periodic and continuous appraisal and evaluation of family health situation and health services are basic to family health nursing care. This helps to meet the changing needs of the family.

·         These services should be rendered to all families without any discrimination.

THEORETICAL FRAMEWORKS FOR FAMILY NURSING:

Family nursing is a specialty area that has a strong theory based; it is more than just common sense/viewing the family as the context for individual health care. It consists of nurses and families working together to improve the success of family and its members in adapting to normative and situational transitions as well as responses of health and illness.

                              Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy and nursing. It is required more theory to get the knowledge to assess and intervene with families.

THEORY- BASED FAMILY NURSING

Among above three theories family social science theories are mostly well developed and informative with respect to how families function, the environment-family interchange, interaction within the family, how the family changes over time, and the family’s reaction to health and illness.

THEORIES:

(1)  Structure-Function Theory:

Ø  The S-F framework from a social science perspective defines families as social systems.

Ø  This theory looks at the arrangement of members within the family, relationships between the members, and the roles and relationships of the individual members to the whole family.

Ø  Emphasis is placed on how the structure supports basic functions of families/vice versa.

Ø  This theory helps to understand the social/family system and its relationship to the overall social system in the community.

Ø  Nurses use this model to talk about the structure, forms or type of family, such as single-parent families, step families, nuclear families or extended families.

Ø  This is a useful framework for assessing families and health. Illness of a family member results in alternation of the family structure and function.

Ø  Major strength-comprehensive approach that views families in the broader community in which they live.

Ø  Major weakness-the static picture of family, which does not allow fort dynamic change overtime.

(2)  Systems Theory:

Ø  A system is composed of a set of interacting elements.

Ø  The family system theory encourages nurses to view clients as participating members of a family.

Ø  It helps to determine the effects of illness or injury on the entire family system.

Ø  Some nursing strategies using this approach include establishing a mechanism for providing families with information about their family members on a regular basis and discussing ways to provide for a normal family life for family members after someone becomes ill.

Ø  Major strength-it views families from both subsystem and suprasystem approach. That is, the interactions within and between families and the larger super systems such as community and world.

Ø  Major weakness-the focus is on the interaction of the family with other systems rather than on the individual, which is sometimes more important.

(3)  Developmental Theory:

Ø  Duvall and miller (1985) presented a synthesis of family developmental concepts. They take the principles of individual development and apply them to the family as a unit.

Ø  Developmental concepts include moving to different levels of functioning, implying progress in a single direction.

Ø  Developmental theory is an attempt to integrate the smaller scale (interactive frame3work) and larger scale (structural/functional framework) analyses of these two approaches while viewing the family as an open system in reaction to structures in the society.

Ø  It helps the nurse in anticipating clinical problems in families ands in identifying family strengths.

Ø  Major strength-it provides a basis for forecasting what as family will be experiencing any period in the family cycle.

Ø  Major weakness-it was developed at a time when the traditional nuclear family was emphasized.

(4)  Interactionist Theory:

Ø  Interactionist theory views families as units of interacting personalities and examines the symbolic communications by which family members relate to one another.

Ø  Central to the interactionist approach is the process of role taking within the family; each member occupies positions to which a number of roles are assigned.

Ø  The ability to predict other family member’s expectations for one’s role enables each member to have some knowledge of how to react in the end indicates how other members will react to performing the role.

Ø  Assessment of families using this theory emphasizes interaction between and among family members and family communication patterns about health and illness behaviors appropriate for different roles.

Ø  It is helpful in explaining family communication, roles, decision making and problem solving.

Ø  Major strength-the focus on internal process within families.

Ø  Major weakness-it is broad and there is a lack of agreement about concepts and assumptions of theory which has made it difficult to define.

APPROACHES TO FAMILY NURSING

For family assessment and interventions, 4 approaches/ways are there:

v  Family as context

v  Family as the client

v  Family as a system

v  Family as a  component of society

Family As Context:

·         Traditional focus on the individual in the foreground and the family as background

·         The family as a context serves as either a resources or stressor to individual health and illness, which is helpful in asking questions regarding the health of individuals

Family As The Client:

·         The family is foreground and individuals are in the background

·         The focus is concentrated on each and individual as they affect the whole family, which is helpful to ask questions to family members

Family As A System:

·         The focus is on the family as a client and it is viewed as an interactional system in which the whole is more than the sum of its parts.

·         This approach also focuses on the individual and family members become the largest for nursing interventions

 Family As Component of Society:

·         The family is a basic/primary unit of society. The family as a whole interacts with each other institutions to receive, exchange/give communications and services.

Smith (1985) suggests that nurses working within the community will discover the family needs. The needs may be:          

ü  Families dealing with normal growth and development

ü  Families coping with illness/loss

ü  Families with inadequate resources or support

ü  Families with disturbance in organization     

Other than this needs, family function must be assessed to determine the realism of the goals based upon four assumptions as given below:

ü  Improvement in the functioning of an individual will elicit improved on the functioning of whole family.

ü  Because of the systematic nature of family, interventions can be directed at any of several levels with a resultant change in family operation.

ü  The nature of the nurse-patient interaction is a crucial part of family nursing intervention.

ü  Family nursing intervention needs to be modified to match different family needs, family styles and levels of family functioning.

FAMILY HEALTH NURSING PROCESS

Family health nursing process is a systematic approach to help family develop and strengthen its capabilities to meet its health needs and solve health problems. It can be implemented at primary, secondary and tertiary levels of care.

The process helps in providing systematic, need based comprehensive health care services to the entire family within the resources available with their active achievement. It consists of 4 phases:

è Assessment phase

è Planning phase

è Implementation phase

è Evaluation phase

(1)ASSESSMENT PHASE

It is the primary concerned with first level/initial assessment which helps to know and explore family and its health needs/health problems and it refers to family identification. The norms/standards foe determining family health status can be-

a)      Normal/optimum of health of individual member.

b)      Family lifestyle conducive to family’s health.

c)      Family environment conducive to family’s health.

d)     Family structure, characteristics and functioning conducive to family health and development.

These norms help the nurse to assess family health status and identify health problems and nursing needs.

Steps for Assessment:

·         Plan for data collection

·         Data collection methods and techniques

·         Analysis of data

·         Family profile and diagnosis

Plan for data collection:

The data collected for doing health assessment depends upon the purpose and scope of family health care.

·         If the purpose is to identify health deficits that is any type of acute/chronic illness, poor growth and development and personality disorder, the focus of data collection will be on information related to existing health deficits and their solutions.

·         If the purpose is to know and explore the family and its health problems/health needs. it requires wide range of information about the family. These include:

a.       Family structure and characteristics

b.      Life style and culture, socioeconomic factors

c.       Health and medical history and health behaviors

d.      Environmental factors

·         The data are collected from primary sources (such as family and its members) and secondary sources (extended members of the family, friends, neighbours, collegues who know the family, family records, health team members, investigation reports, reference books and community health nurses themselves.

Data collection methods and techniques:

Data collection requires professional skills in       making judgments

                                                                               Effective communication

                                                                               Investigations and measurements

Data collection methods:

§  observation

§  Questioning

§  Conversation/discussion

§  Listening

§  Review of family health records

§  Examination

§  Investigation

Analysis of data:  

The analysis includes interfering of health status of family members and the factors which might be associated with/contributing to their health status. It also includes interfering of environment. These conclusions are stated as family health problems and are called health deficits, health threats and foreseeable crisis situations or stress points.

Health deficits-failure in health maintenance and development (actual problem).e.g: personality disorder, deviation in growth and development.

Health threats-it refers to conditions which predispose to disease, accident, poor or retarded growth and development and personality disorder (potential problem).e.g: large family size, immature parents, unbalanced diet, and poor environmental conditions.

Foreseeable crisis situations-refers to anticipated periods of unusual demands on the individual or the family (potential problem).e.g: marriage, pregnancy, labour, newborn.

Family Profile and Diagnosis:

After analysis, it is essential to the family profile and forming diagnosis. Family profile includes all family’s baseline data. Family diagnosis focuses and highlights wide range of factors which influence health and illness status of family members.

(2) PLANNING PHASE (Family health and nursing care plan formulation):

This phase is concerned with formulation of family health and nursing care plan to meet family health needs and resolve family health problems. It involves a series of systematic and logical steps and decision, asking at each step.

Steps:

(1)   Analysis of diagnosed health problems and assessment of family’s abilities to resolve problems that is making 2^nd level of assessment.

(2)   Family’s ability to resolve its health problems can be assessed on the basis of performance of 5 health tasks listed by Ruth Freeman:

§  Ability to recognize the presence health problems.

§  Ability to make decision for taking health action.

§  Ability to provide desired care to the sick/disabled.

§  Ability to maintain conducive environment.

§  Ability to realize community for health care.

(3)   Establishing priorities-refers to the rank ordering of the health problems identified by determining their relative importance on the basis of predetermined criteria.

Criteria-

1.      Types of health problems-health deficits, health threats and foreseeable crisis situations or stress points.

2.      Severity of the consequences of the problems-that is nature and magnitude of the resultant problems.

3.      Modifiability of the problem-that is the possibility of resolving the health problem through nursing intervention within the available resource of both family and the nurse.

4.      Salience-means family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed.

5.      Preventive material-whether the problem under consideration can be prevented, eradicated or controlled if intervened.

(4)   Setting goals and objectives-these should be both client focused and nurse focused.

(3) IMPLEMENTATION PHASE (Family health and nursing care plan):

This phase is concerned with the interaction of community health nurse with the family to put the plan into action. The purpose is to help family to mobilize and develop its competencies and resources to be able to resolve its health problems and meet its own health needs.

Steps:

1.      Review of plan and mobilization of resources-the process of implementation requires review of the overall plan, understanding of approaches and scheduled to be worked out with the family. Regular and periodical contacts should be arranged.

2.      Implementation and documentation-the plan is implemented as it is or modified. It depends upon the resources available and urgency of existing conditions and conditions which may emerge etc.

(4) EVALUATION PHASE (Family health and nursing care plan evaluation):

Evaluation is an ongoing process. It has standards and criteria.

Standards-refers to the desired/expected level of performance.

Criteria-refers to the signs/indications of expected level of performance against which actual performance of nurse/client or both is compared to determine the extent of achievement of goals and objectives.

Evaluation process

 

Evaluation is both quantitative and qualitative. Quantitative evaluation determines the extent of services rendered to the family. Qualitative determines the appropriateness, adequacy, and efficacy of nursing intervention planned and implemented.

Types of Evaluation

Formative- It evaluates family health and nursing care plan as it is planned and implemented to determine its strength and weakness at each stage and its progress towards meeting its objectives.

Summative- It concludes the progress/lack of progress towards the goal after several objective based actions are implemented

Health Education

            Health education encourages clients and families to reach their optimal levels of wellness. It includes the health promotion and life style modification.

A population focused study in Alameda Country, California and Breslow, demonstrated relationships between seven life style habits and decreased morbidity and mortality.

These habits were as follows:-

• Sleeping 7-8 hours daily.
• Eating breakfast almost every day without fail.
• Never or rarely eating between meals.
• Being at recommended height-adjusted weight.
• Never smoking cigarettes.
• Using no or moderate amount of alcohol.
• Engaging in physical activity regularly.

BARRIERS TO PRACTICING FAMILY NURSING

• Many barriers exist that affects the practice of family nursing in a community nursing.
• Most practicing nurse had little exposure to family concepts during their under graduate education and have continued to practice using the individual focus.
• There has been a lack of good comprehensive family assessment model, instruments and strategies in nursing.
• Nursing has strong historical ties with the medical model, which views families as a structure not central to individual health care.
• The traditional charting system in health care has been oriented to the individual.
• The medical and nursing diagnosis system used in health care disease centered and disease are focused on individuals.
• Insurance carriers have traditionally based reimbursement and coverage on the individual, not on the family unit.
• The hours during which health care systems provide service to families are at times of day when family members cannot accompany one another.

CONCLUSION

Family nursing examines a systemic approach to care which can be applied both in hospital and community setting. Working collaboratively with the family, the nurse is able to strengthen the level of care available to the patient and promote the health and well-being of the whole family.

HOME NURSING

 INTRODUCTION:

Home care (also referred to as domiciliary care or social care) is health care or supportive care provided in the patient's home by healthcare professionals (often referred to as home health care or formal care).

Home nursing is nursing care which is provided in a home environment, rather than in a medical facility.

Definition:

Home nursing is “ A specialized area of Nursing practice, rooted in community health nursing, that delivers care in the residence of the client” ANA, 2007

“Home health services” means visiting the sick people at their home and giving them nursing care has been a tradition since early times. At present, in the field of community health nursing. The importance of home nursing is increasing day by day, especially due to unavailability of health services, their uneven distribution, and the lack of resources. These has made home nursing an essential feature for achieving the objectives of home nursing practice. Home health care nursing is defined as the delivery of specialized nursing care services in the home health care setting.

Professionals Providing Care:

Professionals providing home care include: Licensed practical nurses, Registered nurses, Home Care Aids, and Social workers. Rehabilitation services are provided by: Physical therapists, Occupational therapists, Speech and language pathologists and Dietitians.

OBJECTIVES OF HOME CARE

·         Protection against diseases.

·         Providing essential treatment.

·         Providing comfort and relief from pain to the patient.

·         Giving a support and empathy to the patient and his family.

·         Using domestic equipment for the nursing.

·         Providing health education.

·         Giving as much respect as possible to the faiths and beliefs of the family during the procedure.

 GENERAL INSTRUCTIONS FOR HOME NURSING:

·         While nursing the patient at home, one should  remember what Florence nightingale said; first objective of home nursing is to provide nursing, second is to keep the patient and his room in the nursing order and the third is to remove all those shortcomings of cleanliness, which can cause the illness or death.

·         Try to include the aspects of general nursing in the home nursing.

·         It is essential to make family independent in taking care of their health, so their activities should be carefully monitored.

·         As far as possible, home nursing should not affect the daily life and normal activities lf the family and their mental strength should be enhanced.

·         In home nursing it is necessary to take care of the patient’s age, his hierarchy to the family, financial condition, educational background etc.

·         In case of chronic and fatal diseases diversional or recreational and occupational therapy should be used.

·         In home nursing there should be maximum utilization of family resources and items available in home.

·         To increase the participation of family in home nursing, the class sessions should be preplanned. These sessions should be separately organized for the women, men and children.

·         For home nursing the nurse should have a thorough knowledge of the diagnosis, etiology, sources of infection, course of disease, treatment, complications arising from the disease, surgery and aseptic techniques.

·         In the home nursing, it is necessary to pay attention to social, psychological and emotional aspects, because they influence the isolation treatment and the process of nursing.

·         In home nursing the nurse should follow her professional standard and code of conduct (ethics).

·         It should be remembered that 5-6 times actual nursing care given is more effective and benefiting than 10-15 times normal meetings.

 Role of Community Health Nurse in Home Nursing:

·         Recording the history of family to ascertain the cause and duration of illness.

·         Providing treatment and related care.

·         Demonstrating the nursing procedure to educate the family members.

·         Giving medicines as per the standing orders and providing essential nursing care in the grave situations.

·         Supervising the nursing procedures provided by family members.

·         Including the patient himself in taking care of chronic illness (heart, arthritis, cancer, diabetic patients, etc) and giving them mental support.

·         Preparing plans to carry the patient to the hospital or clinic and then bringing him back to his home.

 Simple Home Nursing Procedures:

Hand washing- items available in the nursing bag or home visit bag can be used for washing hands at the home.

ü  Family should be advised to store sufficient water and the family members can be taught the advantages and the technique of washing hands with soap/ash instead of soil, through demonstration.

Thermometers Disinfection: To disinfect the thermometer used by patient, dip the cotton swab or clean cloth in antiseptic lotion and keep thermometer wrapped in it for 3 minutes. After this, the thermometer can be reused once it is washed in clean water with proper technique and then dried.

ü  Thermometer can also be disinfected at home, by making antiseptic solution in an empty bottle.

Dressing: Dressing equipment can be disinfected at home by using the boiling water. Paper bag or waste newspaper can be used in place of kidney tray, for discarding the soiled dressing. For providing privacy, curtain or saree can be used. Soiled dressing can be disposed of by burial or burn. Readymade dressing packs may be used for dressing.

Disposal of Sputum and Faces:

Patient can be given an earthen pot or disposable plastic cup with lid to collect sputum. Some water is kept in the pot so that sputum does not stick to the pot. Daily sputum is removed from the pot and buried in the soil. The cleaned pot can be reused; heating in fire can disinfect it. Disposable plastic cups are destroyed.

Similarly, if there is no sanitary toilet in the house the faeces can be collected in a mud pot. It should be buried after 4 hours of mixing limewater in it.

 Home Nursing Techniques in Communicable Diseases:

·         Isolation: Generally isolation is a problem in home. As far as possible, patient should be kept in a separate room or in a corner covered with curtain. Family members especially children should not come in contact with the patient.

·         Order of Visits: Nurse should visit homes of patients suffering from communicable diseases around noon, while others should be visited in the morning. In every meeting, the family members should be demonstrated the procedures so as the spread of infection can be checked. These include:

v  Alternation in the technique: Keeping the nursing bag outside the room of patient, not to carry those equipments in the bag, which can get infected, wearing apron or a specific saree at the time of visit, all the necessary things should be carried together in the room of the patient, being extra careful in washing the hands, paying special attention to the cleaning of floor and furniture etc.

v  Destroying of organisms: Sputum collected in the paper bag, earthen pot with a lid or in a plate made of leaf (Dona) should be buried or burned in a safe place. Antiseptic lotion can also be poured in the pot.

v  Utensils for serving the food: Serving the food on banana or any other leaf or using plastic disposable material is the best option, as these can be burned after the use, or the utensils used by the patient should be left  in the patient’s room itself. It is necessary to clean them regularly.

A community health nurse should know the process of home visit before providing care to individual at home setting.

HOME VISIT

Home visit is the process of providing nursing care to patients at their doorsteps. The goal of home visit is to provide appropriate nursing care leading to wellness of the patients.

AIMS-

è Protection against diseases.

è Providing best possible nursing in homely conditions.

è Improving the health standard of family.

è Monitoring the health problems and diseases.

è Assessing the health, immunization, nutrition level and environmental hazards to family.

è Reducing the mmr and imr by providing maternal and child health services.

è Providing health education, while visiting/giving nursing at home.

PRINCIPLES-

è Home visit should be planned with purposeful and should be beneficial to patients.

è Home visit should be Regular and flexible according to the need of the patients.

è Home visit should be educative means it gives excellent opportunities for health and education.

è Home visit should be convenient and acceptable.

è The nurse and the family must develop positive interpersonal relationship in their work to achieve the goal.

è Home visit should be based on Scientific and up-to-date technique.

è Home visit should be recorded in a diary and family folder.

COMPONENTS HOME VISIT-

  It includes the activities of the nurse in 5 phases. These are as follows:

(1) Initiation phase- here the community health nurse clarifies the source of referral for visit and also share information on reason and purposes for home visits with family.

(2) Pre-visit activities- gathering the information regarding the home the family and the patient, investigates community resources and plans for the first meeting with the client.

(3) Intravisit activities-establishing nurse-patient relationship, explaining the purpose of visit and acknowledging each family members and seeking cooperation, assess family needs and developing nursing care plan.

(4) Termination phase- it occurs when nurse patient goals are reached, health is restored and the patient can function without nursing actions. Reviewing the visit with family and plan for future visits.

(5) Post-visit- activities include recording and reporting to discuss the problems with colleagues, make solutions and planning for next visit.

ADVANTAGES:

o   Provides an excellent opportunity to implement the nursing process.

o   Provides an opportunity to render services to the family members.

o   Prompt and proper home visits create a good understanding between nurse and family and builds good image of nurse.

o   Help to observe family practices and progress of care given by nurse and others.

o   Convenient for the patients.

o   Facilitate patient control of setting.

o   It is the best option for patients unwilling or unable to travel.

IMPORTANCE OF HOME NURSING:

 Home nursing can be considered important to family members and the patient themselves for the following reasons:-

·          It allows the patient to continue to live at home while receiving care rather than being committed to a nursing home, which is often a traumatic experience for the patient and their family.

·         The familiarity of remaining at home and not being treated in a foreign setting can be comforting to the patient and helps with the healthcare process.

·          If healthcare professionals assist in treating the patient, it provides some relief and respite for friends and family members who may have to spend a lot of time caring for and looking after the patient, which can be a stressful experience.

·         Regular visits from a nurse to the patient's home provide a continuum of care. This means that any changes in the patient's condition or circumstances can be quickly spotted and dealt with accordingly.

·         Appropriate medication can be easily delivered to the patient without the hassle of them trying to get it themselves.

RECENT RESEARCH ON FAMILY NURSING AND HOME NURSING

1.     At-Home Care: Interactions Between Nurses And The Elderly/Family

OBJECTIVE: To understand the interaction process between the elderly and the family and the nurses during home care.
METHODS: Grounded theory qualitative study in a community where 40% of the population is aged 65 or above. The collection of data was made via the non-participating observation of nursing practice during 41 home visits and semi-structured interviews to nurses, the elderly and the family.
RESULTS: the following categories emerged – structural organization of at-home care, diagnostic assessment in context and therapeutic intervention in context.
CONCLUSION: the central category was "Building the relationship in an at-home context", due to the fact that the relationship between the nurse, the elderly and the family is central across the entire care process. The relation is, simultaneously, the context for all the care and a therapeutic instrument.

2.      In a Canadian study a participatory action research approach was adopted  to examine the relationships between families of residents of traditional continuing care facilities and the health care team. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships.

CONCLUSION:

Home nursing is a growing emphasis on providing nursing and care to chronically ill peoples in their homes to enable them to live as long as possible in their own homes. Implementing sounds, rational infection control practices in home care has been challenging since guidelines, standards, and most references has been developed for the acute care setting. Such practices include hand washing, home infusion therapy, respiratory care, wound care, urinary tract care and isolation precautions.  Assessment of the home care environments, cleaning and reprocessing of equipments, surveillance, and implication for occupational health.

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